PATIENT ACCOUNT REPRESENTATIVE II/BILLER

HHC•Indianapolis, IN

14d

About The Position

The Patient Account Representative II/Biller provides timely and accurate billing to facilitate optimized reimbursement, research, and performance improvement initiatives. This includes the verification of billing data for accuracy and completeness, following regulatory requirements, and in order to resolve edits or exceptions detected during system processing of the claim in the patient account system, claim editing system or the payor, reviewing the medical, facility protocol, other applicable documentation, and the understanding of payor denials, appeal, process, and credit balances.

Requirements

Associate degree in business-related field preferred
Two years of accounts receivable experience in a hospital billing environment or two to three years in a financial institution, may be accepted in lieu of formal education
In depth knowledge and the ability to translate code set for billing of federal, state and regulatory laws. The ability to follow Eskenazi Health Services policies and procedures, and of Indiana State Department of Health regulations
Ability to utilize support systems such as Epic, Onbase, NThrive, and/or other software applications
Knowledge of Epic Patient Accounting system
Ability to use computer –key entry and operate a calculator
Extensive knowledge of and ability to research and identify payor billing and reimbursement guidelines
Excellent oral and written communication skills with the ability to present information to groups of clinical and non-clinical staff Ability to lead, supervise and motivate personnel
Excellent customer service skills
Ability to act professionally, be team oriented, and take solution-driven approaches to problem solving for all types of issues
High level of professionalism and ethical behavior
Knowledge of reimbursement methodologies, payor coverages, State/Federal programs providing healthcare benefits and payments
Knowledge of assigned payer(s) billing requirements and regulations
Ability to learn software quickly and interpret instruction manuals
Must be capable of completing tasks within given time frames and be productive and goal oriented
Ability to work independently and within a team with instructions and to deal with problems effectively in collaboration with peers and staff
Ability to quickly learn and use payer and hospital patient accounting systems
Possess knowledge of Health Care Procedure Codes and Uniform Billing standards
Ability to multi-task in a fast paced environment
High level of interpersonal, problem solving, and analytical skills

Nice To Haves

Previous denial management with Medicare, Medicaid, and Insurance is a plus
Previous experience with billing Medicare, Medicaid, and Insurance is a plus
Medical billing and coding certification a plus

Responsibilities

Responsible for the resolution of credit balances that have an outstanding low balance for hospital accounts, in compliance with Federal and State regulatory guidelines for timely turnaround of resolution.
Serves as a resource to other departments to resolve problems and expedite billing and collection processes
Responsible for resolving claim edits for low dollar hospital accounts while adhering to payor guidelines and regulations
Responsible for identifying and trending payor rejections and denials, and also implements system process improvements to prevent future rejections and denials
Answers e-mails and voicemails on a timely basis
Aide and assist on special projects, including providing coverage for team members who are out of the office
Keeps up to date on account billing and collection rules and regulations, contract terms, and conditions with regards to timely filing and service pre-certifications and authorizations
Makes phone calls to patients and insurance companies to obtain information required to resolve patient accounts
Updates job knowledge by participating in educational opportunities; reading professional publications.
Works efficiently under pressure, acts independently, and accepts responsibility for decisions
Participates in monthly staff meetings to educate new payor habits and etc. as needed
Completes payor appeals based on under payment, timely filing, medical necessity, and prior authorizations
Works proactively with departments, and resolves billing and/or issues; resolves Do Not Bill (DNB) errors and warnings, claim edit resolution.
Review and maintain AR denials to ensure KPI measurements are met and/or exceeded; KPI’s are as follows: maintain AR days under 35, days in credit balance less than 1 day of AR, days in denial less than 1 day of AR, and outstanding claims are billed within 7 days of erroring out in the system
Works with management when contract variances are identified
Works assigned patient accounts in a credit balance and claims to resolution
Performs accurate data entry for required information in the various management systems
Completes refund packet within the OnBase imaging system
Maintains weekly Excel spreadsheet of refunds processed
Researches and resolves issues with balancing and posting of patient revenue within multiple systems
Reconciliation of all transactions within the patient accounting system